Oncology: a new hope

The fight against cancer has taken a fresh turn. Scientific, therapeutic, technical and technological progress is advancing exponentially. These improvements will have a significant impact on diagnosis and patient care and also lead to more specific personal treatment of the different forms of cancer, thanks notably to the enhanced use of health data and artificial intelligence.

An epidemiological challengeAccording to forecasts from the International Agency for Research on Cancer (IARC), cancer was the second-leading cause of mortality globally in 2018, with 9.6 million deaths caused by its various forms*. Although lung cancer is by far the most lethal form, causing 1.7 million deaths, or 18% of the total, its prevalence is trending lower in most North American and European countries, due notably to scientific, therapeutic, technical and technological progress. Life expectancy in years is increasing steadily. A highly symbolic figure backs this affirmation, with 43.8 million patients surviving at least 5 years after cancer diagnosis.

A dynamic & profitable marketAccording to international specialist healthcare data consultant IQVIA**, the oncology market will be the main global pharmaceutical growth driver by 2021, with an average annual growth rate of 6-9% over the period. Despite the high level of prices, immunotherapies and genetic therapies, which act directly on the immune system and cancerous cells, should be the most dynamic segments, as reflected by the initial results of CAR T-cell therapies Kymriah® and Yescarta®, which have been marketed in the US since 2017.

Productive R&DThe oncology market will be driven by productive R&D. According to IQVIA**, 631 drugs were in their advanced clinical development phase in 2016, including 39 already patented or with registration underway. Laboratories focusing on this therapeutic domain represent another strong underlying trend. 544 laboratories working in this domain have invested several billion dollars. The range of products under development appears extremely promising. The innovative product pipeline will inevitably contribute to a reduction in the death rate and also an increase in life expectancy, or even the full recovery of many patients. Ultimately, cancer could become a chronic pathology. This premise was inconceivable 20 years ago.

Supporting the right projectsSupporting academic cancer research projects will be a key challenge, alongside financial backing for the biotech companies and start-ups. Many companies have made outstanding progress over the past few years and some have even been taken over by pharmaceutical groups paying top-dollar prices. From this viewpoint, the Nasdaq is a key springboard for innovation, as it is a financial market awash with liquidity and competent investors. Europe is also highly dynamic in this field. A number of biotechs have been very successful, as illustrated by Belgian company arGEN-X, which has now reached 3 billion euros in terms of market cap. The challenge will therefore be to pick the most profitable projects, and here there is an embarrassment of riches.

More dynamic regulationsNational and transnational regulatory authorities are currently developing more dynamic mechanisms to accelerate the availability of innovative treatments, including marketing authorisations, drug pipeline valuations, determining whether drugs qualify for reimbursement, defining therapeutic strategies and setting medicine prices. The variety of available treatments and the multiple combinations of products provide further alternatives for patients, who will be able to benefit from the oncology revolution. Cancer is a major issue for broader society and has now become a public healthcare priority. Governments are working hard to absorb the financial weight of therapeutic innovation and therefore limit opportunity loss for their citizens.

Multiple therapeutic strategiesNew cancer treatments, which are now more numerous and more complex, more precise and more clearly targeted, herald the arrival of innovative and more personalised drugs which are also more efficient. Healthcare professionals will have a broader therapeutic arsenal at their disposal to improve patient care, notably in terms of support and monitoring the sub-populations treated. Organisational practices are changing and will enable interconnection between the various departments within hospitals, town halls and the medical & social sector, in the context of a more highly coordinated provision of care service. The digital revolution will facilitate information pooling and enhance inter-professional cooperation, in the interest of patients.

New players, fresh outlookAs well as laboratories, biotech firms, start-ups and public research teams, new players – led by the GAFA companies – are also becoming involved in the fight against cancer. Healthcare data and artificial intelligence have opened up many new opportunities. These innovations notably enhance accurate earlier diagnosis and also enable tumour profiling. Above all, they will contribute to the development of new technologies, which are more efficient and more precise, ultimately making cancer a tolerable illness. We share this ambitious objective, which we hope can be achieved. Through its deep involvement in corporate social responsibility, Candriam has given this cause its full support by donating 10% of the management fees retained by the Candriam Equities L Oncology Impact fund to leading European cancer research institutions.